应用FibroTouch评估替诺福韦酯治疗慢性乙肝患者肝组织学改变的作用
|
摘要
目的探讨瞬时弹性扫描评估替诺福韦酯治疗慢性乙型肝炎患者肝组织学改变情况,以评价替诺福韦酯对慢乙肝的疗效。方法回顾性分析普宁市人民医院2017年5月～2018年7月住院或门诊资料完整的患者100例,年龄> 16岁,其中男72例,女28例,平均年龄(45.2±9.7)岁,随机将其分成两组,一组接受替诺福韦酯治疗,一组接受一般护肝治疗,观察所有患者治疗过程第12、24、36、48周肝脏弹性值的变化及生化指标、HBV-DNA的情况。结果替诺福韦酯治疗组较对照组患者丙氨酸氨基转移酶(ALT)、Ls及HBV-DNA水平均显著下降,差异有统计学意义(P <0.05)。结论替诺福韦酯抗病毒治疗,能有效抑制病毒复制,改善肝脏组织学情况,肝脏瞬时弹性扫描可作为CHB抗病毒治疗随访检测方法,LS早期快速下降可作为疗效较好的预测因素。
Objective To investigate the effect of tenofovir disoproxil on liver histology in patients with chronic hepatitis B by transient elastic scanning to evaluate the efficacy of tenofovir disoproxil on chronic hepatitis B. Methods A retrospective analysis of 100 patients with inpatient or outpatients of integral records from May 2017 to July 2018 in Puning People's Hospital,aged > 16 years,including 72 males and 28 females,with an average age of(45.2 ± 9.7)years old.They were randomly allocated to two groups.One group received the treatment of tenofovir.Another received general liver protection.All patients were observed for changes in liver elasticity and biochemical indicators at week 12,24 weeks,36 weeks,and 48 weeks,HBV-DNA case. Results The levels of alanine aminotransferase(ALT),Ls and HBV DNA in the tenofovir dipivoxil group were significantly lower than those in the control group, and the difference was statistically significant(P < 0.05). Conclusion The antiviral treatment of tenofovir can effectively inhibit viral replication and improve liver histology.The transient elastic scan of liver can be used as a follow-up test for CHB antiviral therapy.The early rapid decline of LS can be used as a predictor of better efficacy.
Objective To investigate the effect of tenofovir disoproxil on liver histology in patients with chronic hepatitis B by transient elastic scanning to evaluate the efficacy of tenofovir disoproxil on chronic hepatitis B. Methods A retrospective analysis of 100 patients with inpatient or outpatients of integral records from May 2017 to July 2018 in Puning People's Hospital,aged > 16 years,including 72 males and 28 females,with an average age of(45.2 ± 9.7)years old.They were randomly allocated to two groups.One group received the treatment of tenofovir.Another received general liver protection.All patients were observed for changes in liver elasticity and biochemical indicators at week 12,24 weeks,36 weeks,and 48 weeks,HBV-DNA case. Results The levels of alanine aminotransferase(ALT),Ls and HBV DNA in the tenofovir dipivoxil group were significantly lower than those in the control group, and the difference was statistically significant(P < 0.05). Conclusion The antiviral treatment of tenofovir can effectively inhibit viral replication and improve liver histology.The transient elastic scan of liver can be used as a follow-up test for CHB antiviral therapy.The early rapid decline of LS can be used as a predictor of better efficacy.
引文
[1]中华医学会肝病学分会,中华医学会感染病学分会慢性乙型肝炎防治指南(2015年版)[J].中华肝脏病杂志,2016,24(4):307-309.
[2]Gordon SC,Krastev Z,Horban A,et al.efficacy of tenofovir disoproxil fumarate at 240 weeks in patients with chronic hepatitis B with high baseline viral load[J].Hepatology,2013,58(2):505-513.
[3]European Association for the Study of the Liver.EASLclinicalpractice guidelines:management of chronic hepatitis B virusinfection[J].J Hepatol,2012,57:167-185.
[4]中华医学会肝病学分会,中华医学会感染病学分会慢性乙型肝炎防治指南(2015年版)[J].中华肝脏病杂志,2016,24(4):307-309.
[5]Duarte-Rojo A,Heathcote EJ.Eficacy and safety of tenofovir disc·proxil fumarate in patients with chronic hepatitis B[J].Ther Adv Gastroenterol,2010,3(2):107-119.
[6]van B/Smmel F,Schemick A,Hopf U,et a1.Tenofovir disoproxil fu·marate exhibits strong antiviral effect in a patients with lamivudine-resistant severe hepatitis B reactivation[J].Gastr0enter01ogy,2003,124(2):586-587.
[7]Kuo A,Dienstag JL,Chung RT.Tenofovir disoproxil fumarate for the treatment of lamivudine-resistant hepatitis B[J].Clin Gastroenterol epatol,2004,2(3):266-272.
[8]van Btimmel F,Wiinsche T,Mauss S,et a1.Comparison of adefovir and tenofovir in the treatment of lamivudineresistant hepatitis B virus infection[J].Hepatology,2004,40(6):1421-1415.
[9]van Bfmmel F,Z~llner B,Sarrazin C,et a1.Tenofovir for patients with lamivudine-resistant hepatitis B virus(HBV)infection and high HBV DNA level during adefovir therapy[J].Hepatology,2006,44(2):318-325.
[10]Tan J,Degertekin B,Wong SN,et a1.Tenofovir monotherapy is effectiveeffectivein hepatitis B patients with antiviral treatment failure to adefovir-resistant mutations[J].J Hepatol,2008,48(3):391-398.
[11]王陆军,张纪元,冯国华,等.替福韦酯治疗慢性乙型肝炎的最新进展[J].传染病信息,2011,24(4):255-256.
[12]Sehmeltzer PA,Talwalkar JA.Noninvasive tools to assess hepaticfibrosis:ready for prime time?[J].Gastroenterol Clin North Am,2011,40(3):507-521.
[13]Kircheis G,Sagir A,Vogt C,et a1.Evaluation of acoustic radiationforce impulse imaging for determination of liver stiffness usingtransientelastography as a reference[J].World J Gastroenterol,2012,18(10):1077-1084.
[14]Tapper EB,Krajewski K,Lai M,et a1.Simple noninvasivebiomarkers of dvanced fibrosis in the evaluation of non.alcoholicfatty liver disease[J].Gastroenterol Rep(OxO,2014,2(4):276-280.
[15]European Association for Study of Liver.EASL clinical practiceguidelines:management of hepatitis C virus infection[J].J Hepatol,2014,60(2):392-420.
[16]肝脏硬度评估小组.瞬时弹性成像技术诊断肝纤维化专家意见[J].中华肝脏病杂志,2013,2l(6):420-424.
[17]马科,丁红方,黄加权,等.瞬时弹性扫描评估替比夫定治疗慢性乙型肝炎患者的疗效[J].胃肠病学和肝病学杂志,2015,24(9):1130-1132.
[2]Gordon SC,Krastev Z,Horban A,et al.efficacy of tenofovir disoproxil fumarate at 240 weeks in patients with chronic hepatitis B with high baseline viral load[J].Hepatology,2013,58(2):505-513.
[3]European Association for the Study of the Liver.EASLclinicalpractice guidelines:management of chronic hepatitis B virusinfection[J].J Hepatol,2012,57:167-185.
[4]中华医学会肝病学分会,中华医学会感染病学分会慢性乙型肝炎防治指南(2015年版)[J].中华肝脏病杂志,2016,24(4):307-309.
[5]Duarte-Rojo A,Heathcote EJ.Eficacy and safety of tenofovir disc·proxil fumarate in patients with chronic hepatitis B[J].Ther Adv Gastroenterol,2010,3(2):107-119.
[6]van B/Smmel F,Schemick A,Hopf U,et a1.Tenofovir disoproxil fu·marate exhibits strong antiviral effect in a patients with lamivudine-resistant severe hepatitis B reactivation[J].Gastr0enter01ogy,2003,124(2):586-587.
[7]Kuo A,Dienstag JL,Chung RT.Tenofovir disoproxil fumarate for the treatment of lamivudine-resistant hepatitis B[J].Clin Gastroenterol epatol,2004,2(3):266-272.
[8]van Btimmel F,Wiinsche T,Mauss S,et a1.Comparison of adefovir and tenofovir in the treatment of lamivudineresistant hepatitis B virus infection[J].Hepatology,2004,40(6):1421-1415.
[9]van Bfmmel F,Z~llner B,Sarrazin C,et a1.Tenofovir for patients with lamivudine-resistant hepatitis B virus(HBV)infection and high HBV DNA level during adefovir therapy[J].Hepatology,2006,44(2):318-325.
[10]Tan J,Degertekin B,Wong SN,et a1.Tenofovir monotherapy is effectiveeffectivein hepatitis B patients with antiviral treatment failure to adefovir-resistant mutations[J].J Hepatol,2008,48(3):391-398.
[11]王陆军,张纪元,冯国华,等.替福韦酯治疗慢性乙型肝炎的最新进展[J].传染病信息,2011,24(4):255-256.
[12]Sehmeltzer PA,Talwalkar JA.Noninvasive tools to assess hepaticfibrosis:ready for prime time?[J].Gastroenterol Clin North Am,2011,40(3):507-521.
[13]Kircheis G,Sagir A,Vogt C,et a1.Evaluation of acoustic radiationforce impulse imaging for determination of liver stiffness usingtransientelastography as a reference[J].World J Gastroenterol,2012,18(10):1077-1084.
[14]Tapper EB,Krajewski K,Lai M,et a1.Simple noninvasivebiomarkers of dvanced fibrosis in the evaluation of non.alcoholicfatty liver disease[J].Gastroenterol Rep(OxO,2014,2(4):276-280.
[15]European Association for Study of Liver.EASL clinical practiceguidelines:management of hepatitis C virus infection[J].J Hepatol,2014,60(2):392-420.
[16]肝脏硬度评估小组.瞬时弹性成像技术诊断肝纤维化专家意见[J].中华肝脏病杂志,2013,2l(6):420-424.
[17]马科,丁红方,黄加权,等.瞬时弹性扫描评估替比夫定治疗慢性乙型肝炎患者的疗效[J].胃肠病学和肝病学杂志,2015,24(9):1130-1132.